Case studies in health services

¶ … Health Services

Major case theme

The major case theme is the management issues between Harold Goodview who is the owner of Good Views Medical Imaging, LLC and the chief of medical imaging in MacMillan hospital and the hospital management. Goodview had been used to going to Gargon, the hospital chief executive officer directly instead of letting the issue be handled by the organization's vice president of clinical services, Gregory Halton. In addition to this, the hospital's chief executive did not involve the vice president of clinical services in resolution of the issues brought up by Goodview. This led to conflict between the vice president of clinical services and Goodview since the former felt that the latter was overstepping his authority. In addition to this, Halton had also mentioned this problem to the chief executive who did not take any action to resolve this issue which meant that the chief executive as in support of the actions taken by Goodview to go directly to the chief executive.

These issues between Dr. Goodview and the MacMillan hospital management led him to become negligent in his work. Goodview began to review mammograms in a rush which led to many misdiagnoses, ignorance and negligence that led to the second lawsuit where Dr. Goodview reassured Amelia Tendo that the lump was benign and nothing but a calcium deposit while in real sense it was cancerous.

Context of the case

Jack Gargon who was the chief executive of MacMillan was not able to resolve the managerial issues between Goodview and Halton. Halton had raised concern regarding the issues facing the two parties but the chief executive's negligence and ignorance of these issues led to this case in the organization. Halton had been embarrassed numerously through the decisions taken by Dr. Goodview and though efforts were made to develop a better working relationship, Dr. Goodview rebuffed these.

Dr. Goodview also had a poor track record with numerous concerns about the quality of work in the imaging department. Sally Lebeau who was the chief radiographic technologies in the organization had tried to implement continuous quality improvement but since neither Goodview nor the hospital administration was in support of her efforts, there was no overall improvement. There was also a high turnover of radiologists in the department which meant that the department was unable to institute long-term goals and activities since the staff were not committed to the department.

The hospital management as well as several of the board members was well aware of the issues between the administration and Dr. Goodview though nothing was done. There was also increased concern about the quality of imaging services by patients. The issues between Goodview and the hospital management led to Goodview becoming negligent in his work and reading mammograms as fast as he could without giving them the professional consideration they need.

Situation of the case

Goodview's reading and diagnoses had for long been substandard and below the professional level required by all health organizations. The jury was justified in ruling in favor of the hospital and not Dr. Goodview nor his company. This is because even though the hospital had terminated the contract with Dr. Goodview and his company, the hospital had done so lawfully as per the contract between the two parties. In addition to this, Dr. Goodview had defamed the organization by providing substandard work to the hospital's patients. Even though there were managerial issues between Dr. Goodview and the hospital, he should not have resulted to diminishing the quality of work he provides to his clients. This was unprofessional and unwarranted despite the issues facing Dr. Goodview.

In the second case, it emerged that after Dr. Goodview assured Ms. Tendo that her lump was nothing but calcium deposits, she was diagnosed with cancer that had metastasized to her lung, nearby lymph nodes and liver. Ms. Tendo was right in suing Good Views Medical Imaging and MacMillan Hospital for negligence. It was her right to receive quality medical imaging services which she did not and it was also the responsibility of MacMillan Hospital to ensure Dr. Goodview provided quality services to clients in the medical imaging department.

Identity of players or stakeholders

Abner MacMillan is one of the stakeholders. He donated 40 acres towards the construction of the hospital and a sum of $50,000 which was a considerable sum in the 1870s towards the charitable activities of the hospital. MacMillan Hospital's competitors are also stakeholders in this case. They face natural barriers such as a range of foothills and two rivers and they are not well served by the public transportation system. These competitors include the two large hospitals in the region, several freestanding physician-owned centers offering urgent care, ambulatory surgical services and imaging as well as the small psychiatric care facility which offers inpatient drug and alcohol detoxification and rehabilitation. The university hospital which is 75 miles distant of MacMillan is also a stakeholder since they receive complex cases which are referred from MacMillan Hospital. They hospital-based physicians who MacMillan has contracts with are also stakeholders in this case. These physicians provide anesthesiology, emergency medicine, cardiology, medical imaging (radiology), and clinical and anatomical laboratory services. The Joint Commission on Accreditation of Health-Care Organizations which has numerously accredited MacMillan Hospital is also a stakeholder. The status provided by this commission helps MacMillan receive reimbursement for Medicare and Medicaid patients who account for a third of admissions at the hospital. The 21-member board of trustees who are trustees of the trust which was originally established by Abner MacMillan is also a stakeholder in the organization. This is because they make crucial decisions about the hospital such as the decision to change the name from the name of the city in which it was located to be named after Abner MacMillan after his death. The professional staff organization (PSO), hospital administration such as the chief executive, vice president for clinical services, and vice president for medical affairs are also stakeholders in the organization. The chief of medical imaging and the chief radiographic technologist are also stakeholders in the organization. The members of staff of the medical imaging department who were under Dr. Goodview are also stakeholders in the case. The vice president for support services who provide maintenance for the hospitals departments is also a stakeholder. Ms. Tendo who had had her mammogram mistakenly read was also a stakeholder since she deserved to receive quality medical imaging services from the hospital and Dr. Goodview.

Explanation or analysis

Both Dr. Goodview and the hospital management were at fault and had a part to play in ensuring the medical imaging department performed according to expectations and the relevant professional standards. The hospital administration team should have ensured any conflicts between Dr. Goodview and the hospital administration were addressed immediately. In addition to this, before renewing the contract given to Good Views Medical Imaging, the hospital administration should have reviewed the performance of Dr. Goodview and his company and ensured that the physician was performing to the required standards before renewal of the contract. Lack of monitoring of the quality of services provided and lack of strategic decision making regarding the performance of the medical imaging department led to these issues in the department which could have been easily prevented by the hospital administration.